Provider Demographics
NPI:1235290776
Name:GOHEN, GREGG A (DC)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:A
Last Name:GOHEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18933-0078
Mailing Address - Country:US
Mailing Address - Phone:215-918-1500
Mailing Address - Fax:215-918-1503
Practice Address - Street 1:1432 EASTON RD
Practice Address - Street 2:SUITE 5B
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2852
Practice Address - Country:US
Practice Address - Phone:215-918-1500
Practice Address - Fax:215-918-1503
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC2987-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2269680000OtherINDEPENDANCE BC
PA2269680000OtherINDEPENDANCE BC